摘要
目的 评价组织多普勒曲线M型 (CMM )技术检测右心起搏时心室肌的收缩起源和顺序的可行性 ,并比较其组织速度图 (TVI)和应变率图 (SRI)两种成像模式的特点。方法 应用CMM的TVI和SRI成像模式 ,结合同步记录的心电图 ,分别在心尖四腔观、左室两腔观以及心尖左室长轴观评价 2 5例安装右心起搏器患者与 2 0例健康成人局部心肌收缩 (或形变率 )的先后次序。结果 ①正常心肌的收缩起源位于室间隔中部 ,室间隔中部早于心尖部收缩的显示率为 90 %;而右心起搏心律组则显示室间隔心尖部最先收缩 ,TVI图和SRI图显示室间隔心尖早于中部、基底部心肌收缩的比例为 84%和 92 %;正常心肌和右心起搏心肌间的差异有显著意义 (P <0 .0 0 1)。②右心起搏心肌的心室收缩顺序与正常心肌迥异。右室游离壁心尖部和室间隔心尖最早除极收缩 ,右室游离壁较室间隔中部、基底部心肌收缩早 ;左室的侧壁、前壁和左室后、下壁心肌的收缩明显延迟 (P <0 .0 5～ 0 .0 0 5 ) ,并呈现由心尖至心底方向依次收缩减慢的特点。结论 高帧频的组织多普勒曲线M型的速度和应变率曲线 ,为超声准确客观地评估心肌电活动状态提供了全新的定量工具 ,具有广阔的临床应用前景。
Objective To evaluate the feasibility and accuracy of abnormal ventricular systolic sequences using Doppler tissue curved M-Mode velocity imaging (CMM-TVI) and strain rate imaging (CMM-SRI) separately,and to compare the characteristics of two imaging patterns. Methods Onset and sequences of the ventricular contraction were observed and quantitatively analyzed in 25 patients with right ventricular pacing (RVP) and 20 healthy volunteers (Nor.) using CMM-TVI and CMM-SRI. Results ① The origin of contraction was located in the middle of ventricular septum (VS),which was earlier than that of the base and apex segment in Nor. group (90% both in TVI map and SRI map);the contraction of the apex of VS was earlier than that of the basal and the middle segment in RVP group (84% in TVI vs 92% in SRI)( P > 0.05 );there was significant difference in the ventricular activation between the normal contracting myocardium and RVP myocardium( P < 0.001 ). ② The contraction sequences in RVP group were completely different from that of Nor. in long-axis views. The original contraction site was located in the apex of the right ventricular free wall (RVFW),then the apex of VS,the whole of the RVFW,the other left ventricular walls contracted in succession,the time intervals between the Q wave (pacing signal) on electrocardiography and the beginning of the systolic band (or strain rate band) in left ventricular walls significantly delayed than those of Nor. group ( P < 0.05 - 0.005 ). Conclusions High frame-rate tissue curved M-Mode technique appears a promising quantitative tool to accurately provide the phase information. CMM would be more robust in evaluation the electrical conduction combined with TVI and SRI pattern in clinical use.
出处
《中华超声影像学杂志》
CSCD
2004年第5期341-344,共4页
Chinese Journal of Ultrasonography
